Nebraska Biocontainment Unit cautiously watches global virus outbreaks

At a simulation at Offutt Air Force Base, teams practice transporting Ebola patients. (Photo courtesy Offutt AFB)
In 2014 the Nebraska Biocontrainment Unit was called on to treat Ebola patients.
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June 21, 2018 - 6:45am

The outbreak of a pair of contagious diseases half a world away have the attention of a specialized medical team here in Nebraska.



WATCH

"AFTER EBOLA"

This NET News documentary shares the stories of the team who, in 2014, treated Ebola patients at the Nebraska Biocontainment Unit in Omaha.
(CLICK HERE)

"SPILLOVER: Zika, Ebola, & Beyond"

PBS presents an updated version of a program detailing how any given lethal virus has the capability of becoming a global pandemic. (CLICK  HERE for more information)


 

The world became familiar with the Nebraska Bio-Containment Unit four years ago when the group treated patients infected with the Ebola virus.

Recently the re-emergence of two lethal viruses made international news. Ebola in the Democratic Republic of the Congo and fatalities reported in India from the Nipah virus have health officials concerned. (See sidebar) If not dealt with properly, either could result in a pandemic level event.

Much has changed since the team with Nebraska Medicine and the University of Nebraska Medical Center faced its first highly-contagious patients. The group had been training for ten years. What they learned has helped reshape emergency response preparations at hospitals all over the country.

Bill Kelly of NET News spoke with Nebraska Medicine’s emergency response coordinator, Shelly Schwedhelm and Medical Director of the Biocontainment Unit Angela Hewlett about how the re-emergence of Ebola and Nipah is viewed by specialists in the field. Both were in Minneapolis at a gathering of leaders from U.S. hospitals equipped and trained to deal with these patients.

Bill Kelly, NET News: Dr. Hewlett, I'm curious that at what point you start paying much closer attention to news about this Ebola outbreak in the Democratic Republic of Congo.

Dr. Angela Hewlett: We’re always paying attention to what's going on in the world and there's always something going on in the world as far as outbreaks go. Definitely, when we start hearing about cases of Ebola virus and disease, we always start to pay attention. That's because we know what Ebola can do and we know how fast it can spread. That's something that we really want to watch closely and hopefully in this outbreak we'll see some benefit to some of the counter measures that they're using like the vaccine and the public health measures.

Kelly: Has there been a change in the manner in which information is shared among the hospitals who can safely treat Ebola since your experience leading up to the treatment of the patients at the Nebraska Biocontainment Unit in 2014?


TWO THREATS

EBOLA IN CONGO

As of June 16, the World Health Organization (WHO) reports 64 confirmed or suspected cases of Ebola in the Democratic Republic of Congo. (CLICK HERE for most recent numbers)

While news reports heighted this most recent outbreak of Ebola in Congo, WHO is not recommending a travel ban in or out of the country. To date most of the cases have been in rural areas, but there have been cases found in the densely populated city of Mbandaka (pop. 1.2 million) near the Congo River. This increased the risk of “international spread.”

The Nebraska Biocontainment Unit would likely only be called into service if medical personnel or aid workers became infected and proved to be a drain on local treatment facilities.

Map locates recent Ebola cases in Congo. (Graphic: WHO)


NIPAH IN INDIA

The World Health Organization considers Nipah to be “an emerging infectious disease of public health importance” which could bring on a global pandemic. Eleven deaths were reported in May in southern India, including clusters of family members and some health care workers treating the disease. It is an especially lethal disease. Some survivors suffer from permanent brain damage. It has the potential to spread person-to-person by bodily fluids or respiratory paths.

The virus first came to the attention of medical teams in 1998, periodically infecting people from Indonesia to Bangladesh. The most recent outbreak, because of the cluster of deaths in an urban setting, was considered a serious event.


Map identifies history of south Asian Nipah outbreaks (Graphic: Texas St University)


Hewlett: We definitely had some interactions with other places around the world who were caring for Ebola patients in 2014, but for the most part things were sort of piecemeal, kind of put together by members of the CDC or the World Health Organization. Now we have a much more formalized network within the United States of centers that are capable of taking care of patients with Ebola or other diseases of the like, and so I do feel like we've enhanced communication quite a bit. Now there are actually 10 regional centers in the United States with the capability to care for patients with high infectious diseases like Ebola along with the National Institutes for Health. So again, there are definitely more capabilities than we had in 2014, and the communication between these centers is actually very good through the National Ebola Training and Education Center at Utech. So I do feel like we've enhanced preparedness in the United States since 2014.

Kelly: So there are these 10 centers, some with just 2 to 3 bed capacity. Does that still help the Nebraska unit do its job more effectively in the event that there's a larger outbreak?

Hewlett Yes definitely. I think that any enhanced capabilities we have in the Unites States and frankly in the world, all it can do is to enhance our preparedness to take care of patients with these types of diseases, and if there are other facilities in the United States along with Nebraska, then that enhances our ability to care for more patients if the need arises.

Kelly: Have you been in contact as a resource with any of the healthcare providers in Congo?

Hewlett: I have not personally been in contact with anyone over in the Congo as of yet, but I know that there are definitely U.S. citizens that are over there who are taking care of patients, who have volunteered to go either through various agencies, World Health Organization, Doctors Without Borders and others.

Kelly: Shelly Schwedhelm, you're the executive director of emergency preparedness at Nebraska Medicine. There have been a couple of outbreaks of Ebola around the world since your team was called into service four years ago. Is the latest news any different from the other outbreaks in what your team is doing to prepare?

Shelly Schwedhelm: We’re always in a ready state, and so I think that's the really neat thing about this network across the U.S. is that we now have at least 10 regional centers and several actually designated centers within certain states, and a whole tiered structure that's really kind of in a constant state of readiness and collaborating and training routinely, which is something very different than 2014, 2015. So I think for us to say anything's really different right now, I think just heightened awareness because of the additional Americans that are deployed to the Democratic Republic of the Congo, and just heightened awareness that you can get almost anywhere within a day plane ride certainly makes everyone in the U.S. more aware.

Kelly:  Now there were no serious safety issues and certainly no spread of the infection when the Ebola patients were being treated in Nebraska, but in the process of treating those three patients, nonetheless have there been some significant changes in your safety procedures since that time?

Schwedhelm:  I would say that there's no major changes. What we do is constantly fine tune things and find better ways, and so we're just always looking for what would make it more efficient, what would make it safer; what would make it more intuitive for our team. Our team plays a big role in those kind of minor revisions as needed. So big things? No. But minor revisions? Yes.

Kelly: At the same time, there's word of another public health emergency emerging in India, the Nipah Virus, an illness that causes serious brain damage. There have been some fatalities. There's no cure, and there are some indications that person-to-person contact is a factor in some of these cases. Is this a case where your team has to begin looking at treatment and safety issues brought on by a new threat like this?

Hewlett: We're definitely watching the Nipah Virus situation in India as well. It is a virus that can cause some serious illness. I do think that it's possible that it's transmitted from person to person. Nipah would be an infection that we would consider for admission to our biocontainment unit if called to do so.

That's just another example of an outbreak that's going on currently at the same time that we're having the Ebola outbreak in the Congo. Mers-CoV. There's a currently outbreak at risk in the United Arab Emirates. This is an area where there is a lot of travel that goes on between the United States and the UAE. We've got Monkeypox. We've got Lassa Fever in Nigeria. There are a variety of outbreaks that are concurrently occurring in the world that we're keeping an eye on.

Schwedhelm: I think the nuances are such that for different types of pathogens that are transmitted in different ways, we do have some very standard operating procedures, but for the most part they kind of nicely package into two different (categories).

There's no tremendous variation with the viral hemorrhagic fevers, and Ebola, and things in that class. We definitely need to autoclave all of our waste. They are highly infectious and high contagious.

But then the airborne pathogens really take on kind of a new meaning. The incubation periods are a little different. The transmission based potential is different via air and dry land versus contact pathogens are mostly blood and body fluids. Some pathogens are both. It just kind of depends on the transmission route and that's how we vary our standard operating procedures accordingly.

Kelly: Dr. Hewlett, just one last question. I want to ask you about the future of the unit and funding in particular. Is your funding, especially at the federal level, secure? Do you have a sense that these sorts of public health emergencies are still a priority that the federal government is addressing appropriately?

Hewlett: I think that at the federal level the funding for preparedness is something that we can't just be complacent about. A lot of places achieved funding in 2014 as a result of the Ebola virus and these outbreaks but there are lots of outbreaks going on right now; things that we need to watch and things that we could potentially be called to care for.

The funding situation is always in flux. I think continuing to provide funding for not only our facilities but for public health and preparedness in general is only an investment in preparedness efforts for the United States and the world.

I feel like if we do become complacent and if we do forget what happened in 2014, or what's currently happening with some of the other diseases.

I feel that we need to do everything that we possibly can, funding and otherwise, to make sure that we're prepared to take care of these types of diseases so that they don't perpetuate and spread around the United States and around the world. 

Schwedhelm: I think the regionalization approach that we've taken with our federal funding agencies, there's a lot of interest in that model of being able to really have this kind of diverse group across the U.S. be really skilled and prepared for whatever hazards comes up in the region. Then we've done a lot of work really to work within those regions in the varying states. I think a lot of positive things have come out of the 2014 - 2015 Ebola work and really progressed the country significantly in preparedness related to infectious disease.

 

Discussion

 

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